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FOR OFFICE Q, S- ------------------------------- ---- ---------- APPLICATION FOR SANITATION PERMIT Permit No. ------------- ------------------------------------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. : -r_R. -G47 ; JOB ADDRESS AN LOCATION--R__r_F—_ - -�-------�0 R_ .T_EC - .a' Owner's Name------ _p -/4r.- �j FLL.Q.-- -------------------------------- - ---- --------------------------------- ----- Phone-g 23.`_ -s~1.�..- Address------------------------ -A:BaV� Contractor's _ y Installation will serve: Residence E!�^Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ]_____ Number of bedrooms I__'_._ Number of baths -1----- Lot size ----7S__`_X10-------------------_______ Water Supply: Public system ❑ Community syst m ❑ Private [Depth to Water Table 1- ft, Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {if yes,date.___..__..,_.._. I No Er--Kew Construction: Yes ❑ .No ei 1— A/VA: Yes ❑..,--,.No TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----J5__a---Distance from foundation---1Q----------Materipl----40A1C}r -_--------- E�R_ACJ— No. of compartments___ -._.___--_---Size__�LX_X__X__63'`-_Liquid depth----56.__-____-_-___Capacity--- - ------------ Disposal Field: Distance from nearest we]___��......Distance from foundation-----fq---------Distance to nearest lot line_r-�__ ________ ®� Number of lines---------f_._-------------------Length of each line---------- Q-_� Width of trench------- �1l-�-r_------- Type of filter material--_RDC.K Depth of filter material____.�17___._____._.Total length-------------�a--___--__________.__ Seepage Pit; Distance to nearest wel__.,.54__-_.___Distance from foundation----/Q---------Distance to nearest lot 0� Number of pits._.-- _a__...-...__Lining material--PPC -_-Size: Diarneter_Y- 74?....._ ' Dep 9-----------Depth Cesspool:' Distance from nearest•well-----------------Distance from foundation---------___------- Lining material--------------------------_---_-.._.. ❑ Size: Diameter----------------I--------------------Depth------- --------------------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building_..._._._.____._._______--__.--.._... ❑ Distance to nearest lot line- ---------------------------------------------------------------- --------------•------- --------------------------------- r " Remodelingand/or repairing �descrihe):---------- '' --- - --- ----- ------------ ------------------------•-- -----------------------•-- ----------------------------- t ------------------------------------ - ------------------------------------- ------- w_ - ------------------------------------------------------=---------------------------------------------------------------------------:------------------------- ------------------------------------------------- a I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. {Signed} '---------------------- -- - -----------------------------------------------------(Owner and/or Contractor).. , " "'" Title Ii 1 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,'can be placed on reverse side).; FOR DEPARTMENT USE ONLY '-r-- p APPLICATION ACCEPTED BY---- .__t._.!.r\ ,0' ------------------ --------e---------------------------------- DATE----- REVIEWED BY----- --- ------`-------l-k'----------f1U`�PE = J _ T_ _ _ DATE -------------------------------------------- BUILDING PERMIT ISSUED_----------L_f~_ _ce----Fr P- `�` '1` --------------------------.- DATE------------------------------------------------------------- Alterations and/or recommendations:._.. ______C ------------------------------------- 1 -------------------------------------- _ y E --------------------------------------'--------- -- R>49 ------------------- ----------------------------------- ----------------- --------------- - --------------------- --------------- FINAL INSPECTION BY:. - -- ------- ---- -------- -- -- Date------_--- SAN ------ ---SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Sheer.A Stockton,California Lodi,California - Manteca,California Tracy,California 1